Coronavirus Files: Another possible surge looms as world enters third year of pandemic

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Amber Dance | Courtesy Photo

THE CORONAVIRUS FILES

By Amber Dance

March 2020 was when everything changed

This month marks the two-year anniversary of the pandemic. Many Americans started to grasp that something serious was happening as U.S. states began to lock down on March 15, 2020. California issued its shelter-in-place order on March 19.

Two years later, the virus has sickened more than 465 million people worldwide and killed nearly 1 million Americans — though that number is likely an undercount.

More than 10 million doses of vaccines have been administered, but about one-third of the world’s population hasn’t had a single shot.

The World Health Organization now says the “acute” phase of the pandemic could end this year — if every country were to reach a 70% vaccination rate.

On the March 11 anniversary of the WHO declaration of the COVID-19 pandemic, more than 130 prominent figures released an open letter urging more efforts to vaccinate people in middle- and low-income nations, reports Maite Fernández Simon at The Washington Post.

The authors, ranging from former U.N. secretary general Ban Ki-Moon to the Duke and Duchess of Sussex to actor Charlize Theron, pointed a finger at intellectual property rules hindering the widespread manufacture and distribution of vaccines, tests and treatments.

“We must recapture the spirit of solidarity to end the suffering and create a better future,” said co-signee Joyce Banda, former president of Malawi.

Black patients deemed lower priority under some metrics

Nearly 500 patients admitted to the intensive care units of six Boston hospitals in the spring of 2020 were assigned a number between one and eight. That number, based on the severity of their condition and their chances for long-term survival, registered their priority for lifesaving treatments. If a hospital started to run out of resources, those who scored a one or two would be first in line; people ranked six to eight would be last.

Luckily, the hospital didn’t have to institute such care rationing plans. But the scores gave researchers an opportunity to later assess whether the scoring system amplified racial inequities. It did: Black patients were twice as likely to land in the lowest-priority group as people of other ethnicities.

Had ventilators become scarce, the prioritization would have killed more Black people than other patients.

The study, reported in JAMA Network Open, is one of a growing number to assess inequities in pandemic triage. The results have varied: some reports have found evidence of unfair policies, while others have not.

What else could hospitals do? Unfortunately, a fairer alternative has yet to present itself, writes Dr. Hayley B. Gershengorn in an accompanying JAMA commentary.

One option would be a care access lottery, but randomly allocating ventilators would result in even more unnecessary deaths, the study authors calculated.

Or hospitals could take a “first-come, first-served” approach. Or they might end up prioritizing those with resources such as money and connections.

Yet people tend to prefer strategies based on how likely someone is to survive and how long they have left to live, Gershengorn writes.

Instead, she suggests, hospitals must do the best they can with the tools they have, and policymakers must strive to improve scoring systems. She says leaders should ensure that committees developing triage policies are diverse, and that scorers are well-trained for consistent results.

Is U.S. in the eye of the omicron hurricane?

The COVID situation in America is good right now. Cases are down, and so are hospitalizations and deaths. The next “hot vax summer” seems to be just around the corner.

But elsewhere around the globe, the situation is bleaker, due to is a convergence of loosening restrictions, the more transmissible BA.2 variant, and waning immunity.

Cases are rising fast in Europe; Germany’s case rate is breaking national records.

In Asia, parts of China are back on lockdown after facing the worst outbreaks since the pandemic began. Hong Kong, currently overwhelmed by the virus, is also on lockdown and running low on coffins, which are normally shipped from the mainland.

The situation in Europe and the U.K. has reliably presaged U.S. pandemic patterns in the past, and if history repeats itself, the U.S. could be in for yet another wave as the country’s restrictions disappear. Shortly after the U.K. dropped all pandemic precautions, infections and hospitalizations are increasing, writes Nicola Davis at The Guardian. Many cases there are repeat COVID infections, notes Eamon Barrett at Fortune.

And the U.S. may be more vulnerable than the U.K., write Tara John and Isabelle Jani Friend at CNN. That’s because the U.K. boasts an 86% vaccination rate to the U.S.’s 69%; booster rates are lower in the U.S. too.

“What we see happening in the U.K. is going to, perhaps, be a better story than what we should be expecting here,” epidemiologist Keri Althoff told CNN.

The U.S. does have the protection of a high rate of immunity to omicron, due to natural infections in addition to the vaccines; one model estimated that 73% of Americans had immunity in February.

Nonetheless, the BA.2 subvariant has been steadily rising in the U.S., now making up more than one-fifth of cases. It’s already the dominant variant in the U.K.

Evidence of the virus in U.S. wastewater sites is also going up in about one-third of the sites monitored by the CDC.

Of course, the future isn’t certain, and “a spike on the scale of the winter omicron surge seems unlikely,” writes Andrew Joseph at STAT. “Still, if cases rise enough, some of those infections will lead to hospitals and deaths.”

Crucial federal pandemic funding in limbo

The White house is tapping new leadership for the next phase of the pandemic with the appointment of Dr. Ashish Jha to replace Jeff Zients as pandemic coordinator.

Jha takes on this challenge as the pandemic purse is running dangerously low, and Congress is unlikely to release more cash anytime soon, report Tamara Keith and Kelsey Snell for NPR’s Morning Edition.

The crisis comes after Congress stripped $15 billion in COVID funding from a bigger spending package passed earlier in March.

As a result, the White House is warning of harsh cuts to pandemic measures.

This week, it will start to wind down a program that’s been paying for testing, treatments and vaccinations among people who lack health insurance.

The Biden administration will also scale back purchases of monoclonal antibodies and the antiviral Paxlovid. If most people end up needing a second vaccine booster, the federal government might not be able to afford them.

Assistance to makers of rapid tests, research on new vaccines, and assistance for vaccination campaigns in low-income nations will also be reduced.

“To be clear, these facets of the pandemic response were already insufficient,” writes Ed Yong at The Atlantic. “These measures needed to be strengthened, not weakened even further.”

The budget woes could keep the U.S. in a “cycle of under-preparedness,” reports Rachel Cohrs at STAT, with disastrous results if a dangerous new variant should emerge. Waiting until then to release funds would be like “going out and purchasing fire trucks the moment the 911 calls come in,” epidemiologist Michael Osterholm told her. “People will unnecessarily have to die.”

Pfizer, Moderna seek authorization for second boosters

Pfizer has asked the FDA and CDC to authorize a fourth dose of its mRNA vaccine for people 65 and older. The shot would, presumably, amp up antibodies circulating in the bloodstream to protect this vulnerable group.

On Thursday, Moderna then asked for authorization for a second booster for all adults, saying this would give the CDC and doctors the flexibility to determine which of those adults need more boosting. That might include younger adults whose health issues put them at high risk for severe disease.

Such boosters would combat waning immunity with, most likely, a temporary boost in protection. In February, the CDC found efficacy of either company’s booster against hospitalization dropped from 91% to 78% after four months. But the CDC itself framed that number as a positive: It released a media statement saying, “a third dose of mRNA continues to offer high levels of protection against severe disease, even months after administration.”

For further justification, Moderna pointed to “recently published data generated in the United States and Israel following the emergence of omicron,” writes Zeke Miller at AP News.

Specific evidence cited by Pfizer included studies from Kaiser Permanente Southern California indicating vaccine efficacy wanes three to six months after the first booster, and data from Israel, where a fourth shot is already available to health care workers and people aged 60 or older.

For the seniors, preprint data from Israel indicate the additional booster halved rates of infection, compared to only one booster, in January of 2022. Seniors who received two boosters were one-quarter as likely to be hospitalized with severe COVID as those who got one booster.

For adults of any age employed in the Israeli health care sector, the benefits of the second booster were “marginal,” writes Molly Walker at MedPage Today

The U.S. currently allows a fourth dose for people who are immunocompromised.

Experts are divided on broadening the authorization, reports Sharon LaFraniere at The New York Times. While Dr. Peter Hotez told her a second booster now is an excellent idea, Dr. Jesse L. Goodman, former chief scientist at the FDA, said it’s still not certain how much protection against severe disease wanes or “to what degree and for how long another booster might help.”

In fact, giving people additional boosters with the same vaccine formula can sometimes make it harder for the immune system to adapt to new variants, writes Rachel Gutman at The Atlantic. “A fourth shot, then, might give seniors more protection for an unknown period of time against a disease that is currently in decline in the U.S., and it might jeopardize some of their protection against that same disease when cases begin to rise again,” Gutman explains.

Omicron-specific boosters, initially expected this month, have been delayed.

A decision on Pfizer’s application for a fourth shot could come soon, according to The Washington Post.

The Post also reports that the FDA is also considering a COVID booster campaign in the fall, potentially coinciding with the flu vaccine rollout, to cover a wider swath of the population.

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